It’s tremendous vindication of everything I’ve been writing for years, but tragically it has come too late for countless babies, mothers and families.

The Royal College of Midwives has finally, FINALLY, been forced to end its Campaign for Normal Birth in abject failure. Oh, they successfully promoted “normal birth” alright. But they repeatedly sacrificed the lives of babies and mothers on the altar of unmedicated vaginal birth. British health authorities ultimately called a halt to the madness.

Morally bankrupt, blood drenched midwifery leaders, like RCM head Cathy Warwick and midwife Sheena Byrom, never cared about dead babies and I suspect they still don’t give a damn.

In May, the UK’s Royal College of Midwives (RCM) quietly cancelled a long-standing campaign to promote natural births. Separately, doctors are beginning their own more proactive approach to ensuring interventions happen as soon as they are needed. And campaigners have formed a new pressure group called “Maternity Outcomes Matter” to ensure all healthcare staff prioritise safety over the process of childbirth.

What happened?

While it is sensible to avoid medical interference where possible, take this approach too far and childbirth becomes more dangerous, leading to brain-damaged babies and avoidable deaths.

Some of these occurred when women were denied caesarean sections even after begging for them.

The 5.5 million babies born in England between 1 April 2000 to 31 March 2010, resulted in 5,087 maternity claims, involving payouts of £3.1bn, including legal fees…

The most frequent mistakes cited in claims involved management of labour including failure to recognise the baby was in distress from fetal heart monitoring equipment or delay in acting; caesarean section including mistakes and delays and cerebral palsy, where the baby is starved of oxygen at birth and sustains brain damage, often requiring life-long care…

The report said: “Unfortunately, many of the same errors are still being repeated.”

But the RCM continued to promote their deadly ideology and babies continued to die.

In 2015, the Kirkup report on the deaths more than a dozen babies and mothers at at Morecambe Bay was issued and it was a catalog of horrors.

The NHS paid or set aside just under £1 billion [$1.5 billion] last year to settle 1,316 claims of negligence in maternity units, up from £488 million a decade ago, data from the NHS Litigation Authority show. The most costly claims involve babies brain-damaged during labour, who will require constant care for the rest of their lives.

One basic error accounts for a quarter of payouts, with campaigners saying it was a “scandal” that the health service was failing to learn from its mistakes. They blamed divisions between midwives and doctors, saying that the desire for “natural” births — without interventions — sometimes went too far…

But the RCM continued to promote their deadly ideology and babies continued to die.

The number of claims for brain damage and cerebral palsy has tripled in a decade, amid widespread monitoring failures…

… Since 2004/5, the value of claims against NHS maternity units for brain damage and cerebral palsy has risen from £354m to £990m, official figures show.

The cases – often linked with a failure to monitor babies’ heart rates, to detect risks of oxygen starvation – fuelled maternity negligence claims of more than £1.2bn in 2015/16 [$1.5 billion].

I asked at that time: how many babies have to die and how many billions of pounds have to be paid out before the morally repugnant, incompetently trained, self-dealing, deadly UK midwives are held to account?

That liability report appears to have been a tipping point. That was when the Campaign to Promote Normal Birth was quietly shuttered. The fact that the RCM has been silent suggests they hadn’t learned a damn thing and were pressured by higher authorities.

As Wilson notes in her New Scientist piece:

Thankfully, the bad RCM advice has now been taken down, although it’s a shame the midwives’ leaders have tried to do this quietly…

Back-pedalling on the quiet means news will spread more slowly to grassroots midwives and schools of midwifery. There is great variation in practice, and while there are many excellent midwives who prioritise safety, there are also those who may resist change.

If the RCM genuinely wants to reduce avoidable bereavements, it should shout about its change of heart from the rooftops. Most people think of medicine as a field where decisions are guided by evidence rather than ideology. That should be true for childbirth too.

I doubt the RCM has had a change of heart. Their morally bankrupt, blood drenched leaders, especially RCM head Cathy Warwick and midwife Sheila Byrom, have never cared about dead babies and dead mothers in the past and I suspect they couldn’t care less now, either.

The Campaign for Normal Birth was always at heart a campaign to benefit midwives, babies and mothers be damned. It was always about full employment, higher salaries and greater professional autonomy for midwives. If countless babies and mothers had to die to achieve that, Cathy Warwick, Sheena Byrom and the Royal College of Midwives were willing to let them pay the price.

And over on twitter, Milli Hill is putting the boot into James Titcombe (as usual) accusing him of being in league with Jeremy Hunt and various other offences. Lovely woman….

Christina Maxwell

Urgh. I can’t even click the up button for this, it’s all too rancid. I’ve been looking through some burial records in the archive of a local cemetery and it has made me even less tolerant of this rubbish than usual which I didn’t think was possible. The sheer number of stillbirths, premature babies, victims of VPDs etc is beyond belief. And these morons want us to go back to any of that?

mabelcruet

Yes, Byrom is bleating about we’re returning to the misogynistic medical led care of 50 years ago and what a huge shame that is.

She’s protesting that the number of ‘normal’ births has dropped over the years and this is a bad thing. Now I don’t work at the sharp end of obstetrics, and I’m very stupid at statistics, but the reason behind this drop is bound to be multi-factorial and not just driven by maternal choice, which is what she implies is driving it. We have mothers now having babies who 30 years would have been strongly advised to avoid pregnancy because of their own health (we have mums who are transplant recipients, cancer survivors, mums with surgically corrected congenital cardiac disease, far more older mums with medical conditions, and also mums with higher BMI than 30 years ago). So to me, surely a significant part of the explanation that we have fewer ‘normal’ births is because we have fewer ‘normal’ mums (using ‘normal’ here as in no existing medical/surgical/psychiatric or other health issue whatsoever-certainly not intended to be derogatory to anyone).

If the leadership of the RCM displayed some hint of understanding women and taking onboard their concerns, and listening to women who felt bullied and pressured by their midwives during labour, then they wouldn’t be getting slated in the press-but they are coming across very badly in the media at the moment.

I work with some superb midwives and they work miracles daily in a system that is understaffed, underfunded and very hard pressed. The RCM doesn’t speak for them, and doesn’t represent them, and its letting the majority of midwives who do a great job down.

The other reason c-sections have gone up is that they have become safer, due to overall advances in surgery.

When a c-section has a substantial chance of killing the mother, you do it only when there really is no choice, even if you lose a few babies that way. Today, it’s incredibly rare for a woman in a first-world hospital to die of complications of c-section, so why risk the baby?

Young CC Prof

The way these people treat Titcombe is unbelievable, and proof in itself that they aren’t being honest about the whole thing.

mabelcruet

Yes, Byrom is protesting that the New Scientist article was grossly inaccurate, that the ‘climb-down’ by RCM was part of a planned change, planned 2 years ago, and all the information and ‘top tips’ for normal birth have moved to the ‘better births’ initiative so there is no actual climb down or reversal of opinion at all.

And Warwick is still claiming that midwifery adherence to promoting natural birth played no role whatsoever in the baby and maternal deaths in Barrow-in-Furness, even though that is the conclusion of the Kirkup report.

I’d have far more respect for them if they held their hands up and said yes, we were wrong, we need to make it right, but they are aggressively defensive, and aggressively short-sighted, completely hostile and hugely misandrous towards James Titcombe (and any other man) who dares to question or criticize the RCM and their leadership.

Wasnomofear

Right. He’s the real birth warrior here.

Young CC Prof

18 days ago, I gave birth to my second child. RCS, no drama at delivery other than being moved up two days when labor started on its own. She’s beautiful, everything was fine until…

An hour before we were supposed to be discharged, general aches turned into extreme pain shooting through my body, followed by all kinds of not-fun, diagnosis of paralytic ileus, and another two days there.

However, I have one piece of special praise for the hospital: I said, “Something is wrong,” and I was believed. Immediately. The conversation from then on was entirely about symptoms, tests, and possible explanations. No one tried to tell me what I was experiencing was normal, because it obviously wasn’t.

Dr Kitty

Congrats on #2!
Hopefully your recovery from this point onwards is swift and boring.

Sheven

I’m happy that you and your baby are both healthy and glad you got the best care.

Congratulations on baby’s arrival! Happy to hear you had excellent care.

mabelcruet

Congratulations, hope everyone stays well and happy from here on in!

fiftyfifty1

Congrats, YCCP! Thrilled for you.

Box of Salt

Congratulations! Welcome to the new baby and hope your continuing recovery goes well!

moto_librarian

Congrats on your new daughter! I hope that you make a full recovery quickly.

Empress of the Iguana People

Congratulations! Speedy recovery, too.

mabelcruet

Maybe a bit OT, but one of the things that slightly creeps me out about the RCM midwifery leadership is how they refer to themselves as ‘sisters’ and ‘sister midwives’ (especially on twitter). Not sister as in the hierarchy of seniority for ward based staff, but sister as family. I know this happens elsewhere (‘Sisters in chains’ for example) but I think this is inappropriate.

There is a lot of data about safety in teamworking, and one issue that comes up time and again is that dysfunctional teams create risks. Barrow-in-Furness was just one example: the midwives there had more loyalty to their midwife colleagues than they did to patient safety and this collusion amongst them was dangerous. The Coroner pointed this out, as did the Kirkup report. By calling other midwives ‘sisters’, it sounds as though you’ve gone beyond normal professional relationship status. I have some very close colleagues, several of whom have become good friends over the years, but I wouldn’t refer to them as my sisters or brothers. If a colleague was working to poor standards and was putting patients at risk, surely it would be harder to deal with that if you consider them a sister rather than a professional colleague, and perhaps you would be far less likely to take action (which is what Kirkup was driving at). Maybe I’m overthinking it, but its a bit inappropriate.

maidmarian555

The only other time I hear that ‘Sister’ thing regularly is between my Mum and the other members of her weird Jesus cult. They’re all ‘Sister’ and ‘Brother’. That’s what it makes me think of. Slightly unhinged cult members…….

mabelcruet

Yes, I was thinking of cult behaviour too. It’s very Ina May Gaskin-esque.

Lilly de Lure

Yeah – it is a bit cult-like isn’t it – kind of like the way “Aunt” is used in The Handmaid’s Tale.

It also feels like they’re taking advantage of the connotation of ‘sister’ in most laypeople’s minds, for a clinical provider.

Empress of the Iguana People

Depends on the group; African Americans call each other brother and sister a fair bit.

Kelly

Many churches refer to each other as sister and brother too. I do think in a professional setting sister and brother are very inappropriate. There is a reason for using professional titles over familial ones.

Sarah

Sure, I was thinking of a UK context though. Does ‘sister’ have the nursing connotation in the US that it does in the UK? It’s an old fashioned professional title for some nurses here.

mabelcruet

Why are senior nurses called ‘sister’ anyway? I’m sure there’s a historical reason, was it because nurses used to be nuns?

Sarah

I was just wondering the same thing! And what happens if one’s a man?

mabelcruet

What about a male matron? Surely that should be a patron?

mabelcruet

I just googled and the first article came up with the German term for an equivalent ‘Krankenschwester’! Brilliant, I’m off to irritate my nurse friend and call her Krankenschwester….

Busbus

As far as I know, there has been a push to move away from the l old-fashioned term “Krankenschwester” and a lot of nurses I know despise the term. Instead, more gender-neutral terms such as “Pflegekraft,” “Pflegefachkraft” or “Pflegeassistenz” (for nurses with less education) are being introduced now.

mabelcruet

Yes, that was in the article. But it’s such a expressive word-the German language is far more fun than English!

Christina Maxwell

A male ‘sister’ is a Charge Nurse.

Empress of the Iguana People

Not so far as I can tell. Pretty much only referring to nuns or between blacks. My aunt became a nurse in the late 60s and I don’t think she was ever called Sister M.

Sister has never been the title of nurses in the US. It derives, in Europe and the UK from the fact that, until Florence Nightingale, nursing services were provided by nuns.

mabelcruet

Yes, the UK public in general is aware that a ‘sister’ is a senior nursing grade. But then there are nurse specialists now being called ‘consultants’, which I feel could similarly mislead patients to think they are being seen by a medical consultant.

maidmarian555

Yes this! I have an appointment with a ‘consultant midwife’ next week. It certainly feels like it’s designed to confuse patients like me so I don’t start complaining that despite the fact all my paperwork says I’m supposed to be under consultant-led care (and that it what I asked for), that they’ve decided to put me under midwife-led care instead *sigh*.

Dr Kitty

No.
This is your 34week appointment to discuss mode of delivery, I take it?
Do not accept ANYTHING other than an appointment with a CONSULTANT obstetrician.

You need to be a squeaky wheel I’m afraid.
Ask to speak to the head of midwifery services.
Leave a number if necessary, and heavily imply you are considering a complaint.

Explain that you are under consultant led care and have requested an appointment with a consultant obstetrician, that nothing else will satisfy you and that you feel your concerns are not being listened to.

If there is a name of a consultant on your notes, try to get through to their secretary via the hospital switchboard.

If anyone gives you grief, ask for NMC numbers (midwives) or GMC numbers (Drs) and imply that you will complain to the NMC or GMC.

All you are asking for is a discussion of risks/benefits with an appropriately qualified professional in a position to book you a theatre slot for an elective CS at 39w.
If the “consultant” midwife can’t do that, you have no interest in meeting her.
If she does, happy days.

That is the bottom line.

Dr Kitty

Where I work, only OBs can book theatre slots. Perhaps midwives can where you are, but be damn sure before your appointment.

disqus_e9doORxc9t

The last 3 units I have worked in have allowed cons MW to book LSCS.

Also why the emphasis on seeing a Cons?

Busbus

I agree that it’s inappropriate.

I’ve had some contact not with traditional cults, but with people (adults) who were trying to establish cult-like followers in a political youth group context and were using psychological manipulation quite consciously. One of the things that happened was that the members of the youth group who were targeted started to literally refer to the group as their “family” that they would never betray. It was creepy.

Using “family” designations of any kind in a professional context means that boundaries are being blurred that are meant to be there for a reason. Professional boundaries serve to encourage appropriate oversight, individual responsibility, and so on. If a professional group starts to refer to its members as “sisters,” that should ring all sorts of alarm bells.

Lotuseater

Excellent article, and sterling work over the years Amy. A pity UK based obstetricians don’t seem dare to be outspoken against this midwifery tyranny.

Martha G

Some are, but I’ve also seen shocking stuff from UK obstetricians. Some even use the term “too posh to push” and assume that not wanting your vagina shredded must be some sort of “shallow” sex related cosmetic thing. I was shocked when I first read that, as it had not even crossed my mind that this was just one of many benefits of avoiding natural birth.

Lilly de Lure

Junior OBs in particular can be guilty of this – I think its due to the fact that the natural child birth virus has moved from midwives to infect OB training in the UK so we’re now dealing with a batch of young OBs who are as brainwashed as the midwives. Scary stuff when you are totally reliant on them for care!

Christina Maxwell

My hope is that senior and middle rank OBs will now stand up and put an end to that nonsense.

Guest

The UK has seen a huge rise in the deaths of infants and mothers from childbirth complications. This does not just apply to those in the care of midwives. Tens of thousands of UK babies are now being delivered using an archaic forceps extraction method, not popular since the 1700s. This has come back into vogue not because it is effective or safe, but because it is cheap and seen as a time-saving alternative to caesarean section. It has resulted in a dramatic spike in traumatic, often fatal birth injuries. We’re talking fractured skulls, damaged spinal cords, and crushed tracheas. As a parent, I can’t even imagine the heartbreak of losing a healthy baby to this violent and needless procedure.
We’re also seeing fatal outbreaks of “childbed fever” (puerperal sepsis, a malady rarely seen or heard of since the advent of antibiotics and universal precautions), spread by physicians not washing hands or using clean equipment inbetween patients. When surveyed, OBs claimed that they didn’t feel these basic hygenic precautions were necessary when attending “normal, healthy” vaginal deliveries. Even more egregious, doctors fail to treat the resulting infections. investigations into these deaths have uncovered a very distinct trend. The doctors are not treating these patients because they believe that these women are simply complaining unduly about normal postpartum aches and pains and should not be “coddled”.
In response, several UK hospitals have launched “Think Sepsis” campaigns to try and re-educate medical staff on the importance of hand-washing and the basic warning signs of infections. Scary that this is necessary, no?

So as you can see, the problem is systemic. It is not unique to UK midwives. It is, however, driven by the same desire to cut costs, save time, and avoid interventions in pursuit of a “natural childbirth” ideal.

Sarah

Puerperal sepsis, really?

Mattie

From very quick googling, the MBRRACE reports “saving mothers lives” show sepsis as the leading cause of death for mothers in 2011, the latest report shows the leading cause of death as cardiovascular disease. I don’t unfortunately have time to dig too far into the full reports, but there are all here if you want to have a look 🙂 https://www.npeu.ox.ac.uk/mbrrace-uk/reports

Sarah

Thanks. I hadn’t realised sepsis would equal puerperal sepsis, the old childbed fever. Maybe that was dense of me not to make the connection.

Dr Kitty

Personally, I have a *very* low threshold to prescribe broad spectrum antibiotics for anyone with abdominal pain, sweats, malodorous lochia or a vague feeling of unease in the puerperium.

Please don’t take this personally, but with allegations of incompetence of such magnitude, is there any data you can cite? I’m not exactly impressed with what I’ve seen first and second hand of the UK health system, but this is a whole other ball game.

Guest

This comes from the yearly reports released by the NHS and the Royal College of ­Obstetricians and Gynaecologists (RCOG). Each year the RCOG releases new guidelines for practice. Recently, they’ve been focusing on reducing the number of forceps assisted deliveries by promoting vacuum extraction. This campaign has been very successful, and the use of forceps is down by almost half since 2012 (from 13% to 7%) However, they are still used in about 35,000 births a year in the UK. In 2015 and 2016, the RCOG released special reports on the relative safety of forceps delivery in other countries compared to the UK, and determined that the problem was caused by lack of training. Most UK physicians performing forceps deliveries have received very little hands-on training in the procedure, and in many cases it was being done by a trainee, resident, or student without supervision.
This was mostly due to lack of staffing in NHS hospitals during nightshift hours.

Puerperal sepsis is also thoroughly addressed in these reports. It is currently the leading cause of maternal death in the UK.

Anne

From the Cochrane review in 2010 (O’Mahoney F et al), both vacuum extraction and forceps (I presume non-rotational) have similar rates of neonatal injury, but differ in the type of injury. In vacuum, sub-galeal haemorrhage and subsequent hemorrhagic shock is a particular danger, and should be monitored for. Facial nerve injury and skull fracture are specific to forceps, but intracranial haemorrhage rates are not much different between instruments.
The main difference between the methods relates to maternal genital tract injury, where vacuum performs better.

Sarah

I had a vacuum delivery with one of mine, as she was very low but I just couldn’t huff her out as I had nothing in the tank. I understand why forceps is preferable from the mother’s point of view, as vacuum doesn’t seem to tear you up half so badly. What are the other benefits? I realise forceps isn’t used much outside the UK whereas vacuum is more common.

Sue

What is it about the culture of this group of health care professionals that makes them so much out of step with their colleagues?

The midwifery “playbook” followed by many inlcufee a cause about “promoting normal birth”. This is what m many will cite in relation to why they support one mode of birth over another. Until this changes we will continue to have this discussion.

sdsures

“You ought to be able to pass that kidney stone naturally and with minimal intervention and pain management!” – said no one, ever.

mabelcruet

Just practice your breathing!

Young CC Prof

Patriarchy, mostly. Childbirth is “special” because only women do it.

BeatriceC

My most recent brain MRI came back showing a 6mm pituitary tumor (this explains a whole lot of what’s been going on in the last two years). My primary care provider immediately referred me to neurology and endocrinology. Following the midwife model of care he should have just told me to embrace my “variation of normal” since pituitary tumors are fairly common and many of the ones that exist don’t cause trouble. And I just realized this is an even better parallel than I thought, because my PCP is actually a Nurse Practitioner, not an MD.

mabelcruet

But surely this is entirely natural, and some people with brain tumours are meant to die, in the same way some babies are destined to die? Medical/surgical intervention is unnatural, you just aren’t trying hard enough or thinking positively enough.

(TFIC, sarcasm obviously!)

BeatriceC

The scary thing is that’s exactly what the NCB midwife philosophy is if you expand it to include the rest of the medical specialties.

Dr Kitty

6mm is still in the microadenoma range.
Hopefully some Bromocriptine or something similar will sort it out for you.

BeatriceC

Thanks. The neurologist isn’t in much of a hurry to see me. They didn’t give me an appointment until mid-September. I’m assuming if they were too worried they’d have gotten me in sooner.

Mishimoo

I hope it’s relatively easy to deal with, good luck!

Russell Jones

According to today’s edition of The Guardian (US):

“The midwifery trade union will instead start to use the term ‘physiological births’ to describe those without interventions as part
of an overhaul of professional guidelines but will not change its view
that childbirth without medical intervention is best for many women.”

It’s looking a lot like business as usual for the RCM, but with different verbiage.

Sue

Someone is quoted as saying ““What we don’t want to do is in any way contribute to any sense that a woman has failed because she hasn’t had a normal birth. Unfortunately that seems to be how some women feel.”

But isn’t “physiological” just as bad?

Why not just embrace “birth resulting in the best possible outcomes for mother and baby”?

mabelcruet

Absolutely. If you call a ‘normal’ birth physiological, then that implies assisted births are non-physiological, and hence not normal and not natural. It’s a pointless change which is no better than their original terminology. Personally I think its worrying that the RCM is still persisting with the belief that most women want a physiological (normal, natural) birth. Most women want to birth their baby in the safest way for both of them, and if that means intervention by whatever means, so be it. It’s still a birth.

Empress of the Iguana People

There’s no rational reason for a mom to feel her child’s birth by cesarian somehow doesn’t count as having given birth.

mabelcruet

I agree completely, it shouldn’t matter. The birth really is just a means to an end (the end being a new separate person appearing), but I get the impression that many women are heavily invested in this and do seem to feel like they’ve not actually given birth if they were assisted in some way, its like it wasn’t their achievement, and so wasn’t a real birth. There’s been a lot of discussion on here about it, and I remember someone getting very upset when they told someone (I think a midwife possibly) about her section and the immediate response was ‘Oh, I’m sorry’. It shouldn’t matter, and it shouldn’t be such an important part of maternal psyche, but it is.

BeatriceC

I’d like to know why it has to have a special word to begin with. Why can’t it be what it is; an spontaneous vaginal delivery?

Mishimoo

That’s the terminology over here, it’s weird to think it’s such a tough thing for CNMs in other countries to say.

Empress of the Iguana People

aye. you said it better, but that’s why I put “rational” there. Irrational happens way too often. 🙁

mabelcruet

Blame the placenta, all those hormones make your brain go a bit squiffy for a while (plus the pain, the stress, the worry, the whole ‘OMG we have a little alien in the house and I don’t know what to do!’ panic), so I’m not at all surprised mums (and dads) get into odd and irrational ways of thinking about events.

Roadstergal

Why not cut to the chase and call low-intervention births “Midwife births”? Since that seems to be the focus.

sdsures

I thought that’s what they are already called in the UK.

Mattie

Not really, it wouldn’t make sense, seeing as midwives do almost all the births…even the ones with interventions. Some midwives are even trained to do ventouse births, although not forceps.

sdsures

Midwives doing ventouse births sounds like they’re really pushing the envelope with something that ought to be done by OBs in theatre.

Mattie

I’m not sure how many midwives are trained in instrumental delivery, also I have seen many instrumental deliveries done by doctors in-room, not in theatre. That includes both ventouse and forceps. I’m not sure if any of the midwives at my hospital are trained in instrumental deliveries, but I know that’s an option for CPD, like training in water births.

Sarah

Really? I thought there had to be an OB for that.

Martha G

No, but women can choose to go “midwife led” or “consultantant led”

Martha G

With midwife-led invariably sold as the “nicer” option. Most of my mum friends over 35 or even over 40 spent much of their pregnancies thinking they could give birth in a pool in one of these places. They make them out to be like spas.

Sarah

It is. And they look a lot nicer too. Spas, yes, that’s the vibe.

sdsures

Sometimes women have no choice but to go with consultant-led care, because they are high-risk right from the get-go. Sure, midwives will see them for routine pregnancy checkups, but when the day comes, some women MUST have c sections.

Mattie

I get that you mean that it’s best for some women to have a c-section, but the way you’re framing it is like they don’t have a choice. They always have a choice. Informed Consent is not informed if you don’t explain all the options and the risks of each. You are correct in that women will be placed on a ‘care pathway’ appropriate to them at booking, I’m not sure they’d have much choice in that regard, but seeing as all ‘consultant led’ care means is a few more appointments with the hospital during pregnancy, it’s unlikely many people would fight that.

sdsures

If a woman is going to die without a c-section, then it is not a choice.

Russell Jones

There ya go! It gets the point across, and is much pithier than “Births in Support of the Financial Wellbeing and Socio-Political Agenda of Organized Midwifery.”

Casual Verbosity

That goes a (very) small way to minimising the linguistic valuing of unmedicated vaginal births with words like “normal”, but language being what it is I’m sure that in the context of birth ‘physiological’ will have acquired similarly problematic connotations.

Sheven

Why does there have to be a different term at all? You’re giving birth no matter how many or few interventions you have, or what kind of interventions you choose.

elective c for me

They should call it an “unmedicated vaginal birth” because that’s what it is.

Sarah

I might be wrong, but I’d heard they counted a birth with gas and air as ‘normal’ too. It’s very widely used in the UK.

Mattie

I think so, I think anything that isn’t a ‘medical’ delivery is counted as normal, although they may include ‘epidural’ as medical which is crap IMO so if a woman has gas and air or pethidine, it’s still normal if she doesn’t have augmentation, epidural, instrumental delivery or c-section

Martha G

Yes. See also use of forceps (common in UK, almost unheard of in many other civilised countries) .

Gas and air is almost universal in labour over here. I don’t know that was not the case elsewhere

Sarah

I don’t mind gas and air being an option in itself, though it did nothing for me, it’s the way it gets used as a substitute for more effective and labour intensive pain relief techniques (no pun intended).

Martha G

Yes agreed, it’s popular because it does nothing IMHO

sdsures

Why is gas and air even offered as a placebo? It’s a waste of money and resources because it does nothing.

Martha G

Because investing in women’s pain has historically been seen as unnecessary, and until the internet came along and exposed the injustice, it was largely allowed to continue. See also mesh scandal.

mabelcruet

Because it can be prescribed by midwives without needing to involve a doctor, so it keeps it all within the sisterhood.

Similarly with pethidine-the most useless analgesic known to man is still used extensively because midwives can prescribe it.

sdsures

“Whee! I can do something the same as a doctor does, but without all that extra education!” – power trip?

Nurse-led practices for certain things such as asthma, birth control and diabetes are good because they free the doctors up to deal with not-routine cases.

But pain management isn’t the same as regular asthma, diabetes and contraception management. It’s more complicated and far more dependent on the needs of individuals in terms of nuance. We shouldn’t be forced into getting substandard pain management just because it’s cheaper.

mabelcruet

I agree completely, but this is the direction health care in general is taking in the UK. We are developing a huge raft of mid-level providers, a mix of ‘practitioners’, ‘advanced’ roles, physician associates etc. These are supposed to be cheaper than doctors (both to train and to pay), leaving doctors to deal with the complex cases.

In my own area, biomedical scientists are starting to take over roles that medical pathologists traditionally do (specimen dissection and biopsy reporting). The biomedical scientist roles are being taken over by medical laboratory assistants. I have my doubts about the wisdom of this-I agree that a sizeable proportion of my work is fairly routine, and day to day some of it could be done by someone with fewer years of training. But this isn’t predictable at all and having the background I have means I can pick up on the oddball cases easily. Someone who has been trained to work to protocols and standards with no deviation and no variation without having the background of medical training isn’t going to have that flexibility of thought or diagnostic ability.

Sarah

I’m going to have to step in and defend pethidine here, it worked beautifully for me when I was in prodromal labour and needed to be knocked out to sleep! That’s not to say it was optimal, but nor was it useless.

mabelcruet

Glad to hear it, you’ve obviously got the right enzymes to process it! My poor sister isn’t an opioid converter-we discovered it when she had gallstones and the GP prescribed huge doses of codeine that had no effect on her, the amount she took would have floored me for a week, but for her it was like eating sugar pills. She’d have got better pain relief from kiddie aspirin!

Sarah

Hmm, kiddie aspirin is about the only thing they didn’t try and fob me off with when they were refusing to give me an epidural…

Mattie

It does work for some people, and in a few cases (ok fair, rare cases) it works better than epidural. Not because it’s more effective, but because epidural just doesn’t work for some women. It’s cheap, and it is effective for some people. Choice is good, wouldn’t want to stop anyone getting an epidural but I also wouldn’t want it to become the only option.

Sarah

It had no effect on me, but I know some women who loved it. That could be the placebo effect I guess.

maidmarian555

I don’t understand why they’re so afraid of the word ‘vaginal’. I mean, that’s what they’re desperately trying to find an appropriate word to describe, why cant they just call it what it is? It’s really odd for a profession who spend an awful lot of time involved with female genitalia to be scared of the word ‘vagina’ or ‘vaginal’.

“What we don’t want to do is in any way contribute to any sense that a woman has failed because she hasn’t had a normal birth. Unfortunately that seems to be how some women feel.”

Urgh.

So basically they’re blaming women who’ve not had a ‘normal’ birth and their pesky feelings rather than admit this is most likely to do with pressure from within the NHS and from government after the scandals at Morcombe Bay and, more recently, at Telford. Babies and mothers have died as a direct result of this ideology but God forbid they take any actual public responsibility and apologise.

Lilly de Lure

It is the cassic notapology isn’t it – we’re not sorry we’ve done something wrong, we’re just sorry you are oversensitive.

Casual Verbosity

A wise person once told me “normal is the cycle on a washing machine”.

There’s a real danger with labelling unmedicated vaginal birth as “normal” because the word no longer means simply “standard” or “regular” but has developed connotations of moral value. We all know what happens when we value a particular method of birth over a healthy outcome.

Heidi_storage

Right–“normal” really means “normative” in this context, leading to promoting a certain ideology over optimal outcomes.

sdsures

Even a washing machine has hiccups sometime, but not usually to the point of causing death or disability.

Guest

I love your washing machine quote.

mabelcruet

And the bullying and aggression continues. Sheena Byrom has complained on twitter that the New Scientist article is misleading and not factual. The author has asked her to clarify what she, Byrom, considers to be factual errors. Byrom wants to email the author, but the author has said she would prefer this exchange on twitter (obviously because her integrity has been questioned in public on twitter). Byrom has asked her to provide her with name of the authors supervisor. Seriously? She’s behaving like a 5 year old-‘I’m going to tell on you’re.

That’s what she did to James Titcombe, if he tweeted anything she didn’t like, she complained to his employer, repeatedly copying them into his tweets.

Obviously there will be some financial imperative here, it would be naive to think otherwise but I think there is also a genuine belief that things have gone badly wrong and that needs to be put right. Maternity care in the UK (including where health is devolved) is inefficient, ideology bound and far too expensive* for the end result it produces. Doctors seem to be cowed into going along with the worst of the midwives (outnumbered, maybe?). Resources are wasted, Midwives in hospitals are often overworked whereas those in offsite units are twiddling their thumbs a lot of the time. Women giving birth in MW led units are treated to single rooms, ‘home like’ surroundings etc. while those in OB units are often still in multi bed wards which were out of date 30 years ago. BFHI type ‘care’ has been happening here since at least 1990, causing misery to those mothers who are seen as ‘non compliant’.
*Not saying we should spend less, just that we could be spending better. If half the money spent on lawsuits and yet more ‘birth centres’ was directed instead to improving things for the majority the UK would be a much happier and safer place, maternity care-wise. Oh and if people want to birth at home, with the at least two midwives needed and an ambulance on standby in some areas, they can bloody well pay for it.

Mattie

I agree with a lot of what you’re saying, we could save a lot of money (and redistribute midwives) by closing stand-alone MLUs. I disagree with you about single-rooms, most (all?) hospitals have single rooms for labour/birth, regardless of whether that is Midwifery Led or Consultant Led. Antenatal and postnatal wards are multi-bed, yes, but women use or don’t use those regardless of where they gave birth. It would be amazing to have single rooms for postnatal women, but I’m not sure that even if we can save money by closing stand-alone units it would be enough to fund that.

I can never get behind forcing some people to pay for their care on the NHS, it goes against the entire institution. Also midwives have a duty of care to pregnant people and their babies, so that means supporting them even if they do things against medical advice (like have a risky home birth).

Also midwives have a duty of care to pregnant people and their babies, so that means supporting them even if they do things against medical advice (like have a risky home birth).

I disagree with this, actually. If someone insists on going against medical care, the doctors have no obligation to support them in their stupidity. We don’t require GPs to give out antibiotics to people just because they ask. We don’t require neurosurgeons to perform brain surgery because someone thinks their migraines are from a brain tumor even though no tumor can be found. So why would we require an OB or a midwife to attend a birth against all medical advice? Answer: we don’t. We can’t stop people from being stupid, but we can refuse to countenance their stupidity with the appearance of official sanction. A doctor or midwife who attends a horrifically risky homebirth is taking on a huge heaping of professional liability and personal responsibility that is better avoided altogether by refusing to have anything to do with it.

Mattie

I’m not sure, like, you’re right that you can’t force a practitioner to perform surgery just because you want it. But I think leaving a pregnant person without care is worse than providing care, and I’m pretty sure that’s what the current regulations are.

A person CAN demand a homebirth and they have to be cared for (I don’t think this actually happens all that often). A midwife/doctor providing emergency care to a woman who is choosing to birth at home against advice would not be liable because the woman would have had the risks explained to her by multiple people and her decision documented basically everywhere. The ideal situation would be that through discussion, the midwife and client would come to a suitable arrangement that was safe, that’s what happens in most cases.

Most people completely against medical advice choose to free-birth anyway, and they are legally allowed to do that.

Mattie

Also, this doesn’t mean that any one midwife should be forced into a situation they are uncomfortable with. With any high-risk birth there is huge potential for something bad to happen, if the midwife doesn’t feel able to cope with the risks (they might be newly qualified, have less experience with home birth, or just feel unhappy with the situation) then the ‘duty of care’ is that the woman is cared for by a trained midwife, not by THAT midwife.

DaisyGrrl

But part of being a trained health care provider is knowing the limits of your competence. There are some women out there who are soooo high risk that no reasonable, trained midwife should be willing to provided care. This leaves the midwives who might be willing to practice beyond their scope, and risks the patient believing that the care they’re receiving is acceptable and perhaps safer than it is in reality.

Mattie

Oh completely, the fact that the birth is against medical advice suggests that the doctors and midwives are not ‘willing’ to care for the pregnant person.

But they still have a duty of care, so it sort of creates a stalemate. Either the HCPs knowingly refuse to care for someone who will likely need care and then bad things might happen, or they work outside their scope of practice and bad things might happen.

If they can’t break the stalemate through discussions with the client, then they carry out a risk assessment to try and ‘cover’ the potential problems and reduce the risk as much as possible, this might mean having obstetric/paediatrician backup on standby, or having more midwives at the birth, attending drills, having a midwifery supervisor present.

I’m not sure if it’s the law, or the NMC code, or what, but I don’t think a midwife is allowed to refuse to provide care to a pregnant person.

sdsures

I would hope that a midwife WOULD refuse to provide care to a pregnant person if that patient had high-risk factors that were outside the midwife’s competence, legality to treat?

Mattie

But I don’t think they can? Like, I think if a person was refused care and something went wrong then the HCPs would be liable and might even lose their registration. The person MUST be cared for, even if they are going against advice. It would be the same as if a low-risk woman became high-risk during birth but refused transfer, the midwives couldn’t make the person transfer, and they would have to continue providing care to the best of their ability.

Amazed

Many years ago, a doctor’s doorbell rang after working hours. The doctor had set his office at home, so he could always be found, although he had the standard go to the ER warning and all. But he rarely refused to see patients after hours. This time, he did. It was his nameday, he was throwing a party and he had had a couple of drinks. He referred the patient to the ER. The patient did not go because he wanted this doctor and he was like, “Why won’t he do it for me when he does it for everyone else?” And at night, he suffered a cardiac arrest. He and his family sued the doctor. And the physician was found not guilty. He had done everything right, including referring the patient to wher he should go. If he had accepted and examined him while drunk… The patient was deemed an adult who had received a proper advise but sadly, he had not utilized the help that was available.

How is it different for a homebirthing mother who has been warned ahead of time that a certain doctor/midwife/hospital were unable to provide her with adequate help?

mabelcruet

No, that’s not so, at least not in medicine. As a medical doctor, I cannot be forced into treating a patient who is demanding that I do something harmful or detrimental to their health. The General Medical Council has guidance on this-it recommends that I try and discuss this with the person and ensure they are aware of risks, but I cannot be forced into doing something I consider dangerous. It’s different in an emergency situation, but even then a doctor should ensure they provide care that is competent.

For example, you can’t demand that your GP attends your delivery at home, but if you went into labour whilst at the GP surgery when you were attending for another reason, your GP would be expected to provide you with emergency care until you got taken to hospital.

Mattie

It may then be different for midwives, all I can find is the UKCC (old name for the NMC) position statement where it says that

“16. “…the midwife should not refuse to continue to provide care for a woman on the basis of where the woman wishes the birth to take place.”

This is from 2000 so potentially dated, but I can’t find any indication that this has changed.

Mattie

There’s also this from 2006, which ‘replaces previous home birth guidance’.

“Whilst a midwife must not provide care that she is not competent to give, it is not acceptable to refuse to care for a woman on this basis and take no further action.”

The action recommended includes

“Take steps to update her own knowledge and skills to gain such experience so she can support the woman

• Seek help from her manager or supervisor of midwives to gain support to do this.

• If time is limited, refer the care of this woman to colleagues who have the competence, then take steps to update herself to ensure she becomes competent for the future.”

Also this about risk

“Midwives may have some anxieties if there is a clash of a woman’s choice versus the perceived risks of caring for women in a home setting. If there is a clash then the midwife must continue to give care but can seek support by discussing her anxiety with her supervisor of midwives.”

So yeh, they have to provide care, or refer to another midwife who can provide care. High-risk isn’t a good enough reason to not provide care, even against medical advice.

I know one British community midwife — who had a blog, btw, some years ago — who eventually resigned and retired because she could NOT refuse to attend any woman who insisted on a home birth, even when the woman was absolutely not a candidate for one. At the time, the rule was that, if the woman could not be convinced by OBs or other senior medical staff, to go into hospital, the community midwife was obligated to attend her. This midwife felt she was being coerced into dangerous situations, and had no alternative but to leave the profession.

We may wind up just disagreeing on this one, which is fine. I think if someone is demanding a homebirth that is medically unsafe, a healthcare provider can and sometimes should say “well then I can’t be part of this. The risks are too high and I cannot in good conscience work with you while you take such risks”. No one actually does have a right to be cared for in a homebirth- they have a right to medical care, sure, but they have the right to appropriate medical care. Actively dangerous care that flies in the face of best practice is not something that anyone has a right to demand or receive.

If a midwife is willing to attend a homebirth, that’s one thing. The mother does not have a right to demand a midwife attend the birth, though- she either finds someone willing to attend or not, and if a healthcare provider (HCP) does decide to attend, they are giving it their official okay. That also means the HCP is officially liable if anything goes wrong. Now, that’s more US law than UK law, but still … I think the same general principle applies.

sdsures

But then they come crying for medical help when something inevitably goes wrong.

Mattie

Do you mean people who choose to ‘free-birth’? Yeh, it’s a massive risk, most midwives caring for someone who wants to free-birth discuss ways to make it as safe as possible, so that is sometimes having the midwife present but in another room, or sat outside in the car, or present but not touching the woman unless the woman ask. Of course all those things are not ‘correct practice’ but you can’t force a woman into accepting care, but you can be on-hand if something went wrong. Midwives are still capable of managing emergencies, and most people who free-birth don’t want their babies or themselves to die.

sdsures

“Do you mean people who choose to ‘free-birth’?”

Yes.

sdsures

“…you can’t force a woman into accepting care…”

Even when someone is brought unconscious into A&E by ambulance, it is assumed they want care. If they are conscious when brought to A&E by ambulance, it is assumed they want care.

If not – either they or their next of kin must sign something to that effect (e.g. DNR previously discussed with their own physician and countersigned by a notary), or the conscious patient signs consent forms right then.

Mattie

Yes, but if a person is REFUSING care, you can’t ignore that and do what you want anyway, even if what you want will save their life. If they are unconscious then they can’t consent/refuse so you either act in their best interests or ask someone else to make that decision. Women in labour who choose not to go to hospital are still competent, they can’t have treatment forced on them. But HCPs still have to care for them, they couldn’t just leave them to it. They care for the person as best they are able within the constrains presented to them. It’s the same in hospital, if a person is refusing a vaginal examination, or refusing induction, or refusing continuous monitoring…then you can’t force them on to that person. You just ‘manage’ within those parameters. You can’t just say “oh ok, well if you don’t do this then I won’t care for you”.

Juana

But I wonder what the difference is between a woman in labour refusing to go to a hospital for birth (thereby forcing a midwife to attend her at home, per your arguments) and, say, a man with chest pain (myocard infarction yet to be ruled out) who calls an ambulance, but then refuses to be admitted? In both cases, a real standard of care can only be had at the hospital, and in the latter case, no one would argue that an EMT has to stay at the man’s house to supervise him until his chest pain subsides. Why is it so different with homebirthing women?

sdsures

Does a man ever refuse treatment for a kidney stone?

Amazed

Personally, I think leaving 5 birthing women without care in the hospital when the midwife is pulled off to attend to Her Homebirthing Highness’ lofty needs by knitting there in the corner as HHH performs the sacred empowering feat of letting her body do what it was made to do but wants the midwife close just in case her body shits by shutting up is far worse than leaving HHH to meet the consequences of her bloody choices.

Real case. Maidmarian555 experienced midwife-not-lead birth firsthand when a homebirthing princess called up to say that her blessed hour had come and she needed her handmaiden to rub her princessy feet.

Homebirth? I’m all for it. Your body, your informed choice, not my business to stop you. But make it known to the homebirthing goddesses-wannabe that not a single midwife will be pulled out of shift, breaching care for women who are giiving birth at the moment to attend to her. She gets whomever is expendable at the moment. If there is such a person. After all, she believes in herself, her body, and her baby. Why should women who really make the safest choice be placed in a situation that is patently unsafe just because she’s enamoured with being Mother Earth?

Mattie

Inability to provide care due to staffing levels is a real and present problem, and it should never happen. Again though, you can’t knowingly leave a person at home without care, you must provide care to that person, even if it means increased pressure on labour-ward midwives. If you absolutely cannot attend a homebirth then that should be viewed as an unacceptable failure to meet practice standards and a review should happen to make sure it doesn’t happen again. Hospitals need to factor this in, either by employing bank staff or contracting independent midwives.

Unfortunately there just often isn’t enough money for this 🙁 also in labour midwives should be 1:1 not 1:5

Amazed

You can’t knowingly leave a person without care at home is an unacceptable failure but when you leave people without care at hospital, it’s just a real and present problem? I’m sorry if I misunderstand but it looks to me that you’re placing attending the homebirthing mother as a higher priority than attending the hospital birthing mothers who, besides everything else, are more numerous. Why is leaving five women without care worse than leaving a single woman without care? Because they’re in the hospital already? It isn’t as if the equipment will rise to life and start working on its own.

In thinly spread staffing resources it’s downright criminal to take a provider to attend anyone at home when this provider is doing their best to do the work of 5 other people in the hospital. Because this way, you betray hospital patients.In Australia, it’s pretty normal for a midwife from the homebirth program to say, “I’m sorry but I’m stuck at another birth. You’ll have to go to the hospital now.” Generally, mothers don’t scream their heads off like petulant toddlers that they really, REALLY want a midwife. Like grown women, they understand that there has been a hitch on the road and go to the hospital, thus not depriving other birthing women from THEIR providers.

Really, “we need more midwives!” and “oh, it’s no problem for you to demand TWO midwives to attend your lovely psysiological birth at home” are two statements that cannot exist together.

Mattie

Because the hospital has other staff, other midwives and doctors, the home has NO other staff. You would be leaving your 1 woman to be cared for by another midwife in hospital, to care for 1 woman who has no medical support at all.

Amazed

Maidmarian555 disagrees. She and 5 other women WERE left with a breach of care in the hospital, resulting in delay in her own induction and, thankfully, short-term problems.

You’re speaking of the ideal, wishful case. She speaks for how she experienced the REAL thing.

And “your 1 woman”, really? I thought hospital midwives were so overworked that they cared for multiple women at the same time.

Really, why are you so stuck on neglecting the NHS financial position here when you’re considerate of it re: single rooms? Are you talking about reality, or how things should be (but are not?)

BeatriceC

The other thing with ambulances at sporting events is that there’s generally a few thousand people there. So when you factor in the high chance of an injury from the players themselves, along with the high chance of a medical emergency or injury when that many people are gathered in that small a space, it’s not an unreasonable use of resources even if the sports teams weren’t paying for it themselves.

Sarah

The large distinction is that birth is going to happen anyway: the body is going to go into labour, unless the mother dies first. Whereas nobody’s automatically going to have heart surgery or a course of antibiotics. Those things require the action of someone else performing them. There’s no comparison.

That is not to say there isn’t a problem with resources being taken from the hospital environment, where they can be more efficiently used, and sent to someone’s home where of necessity there’ll only be one midwife.

And if nothing goes wrong, the mother’s body will be fine with labor (as will the baby’s). The only reason we have people there is if something goes wrong, same as heart surgery or a course of antibiotics. They’re all there to fix things- a heart that’s gone wonky, an immune system that isn’t doing its job, a labor gone wrong. All three require the active intervention of an autonomous human being (the doctor/nurse/surgeon/whoever) who cannot be forced to attend, do procedures, or provide medication against their professional best judgment.

I mean, looking at it from a purely pragmatic standpoint, you’re also right that resources are horribly wasted on a homebirth because it’s just not efficient to do things that way. But I think the philosophical argument that doctors aren’t just a service provider, and you can’t order them to do things that you want if it’s not medically sound, is also really important.

Sarah

I can understand the argument that doctors shouldn’t be obliged to attend patients doing things they’ve been advised against doing, there’s just still a difference between a doctor actively doing something and being there while it happens. They’re distinct, but it’s legitimate to oppose both.

True. I’d just think (and again, this is hugely US-biased) that if a health care professional (HCP) was present and didn’t do anything, they’d be so liable if things go wrong. For example, a woman gives birth and things go pear-shaped, and the HCP just kinda stands there watching. That’s … not why they’re there. The mere presence of the HCP sort of implies that they can and will be able to fix things; their presence is a promise of that, in fact. And sure, not everything is fixable, and sometimes things go wrong in amazingly unique ways. There are no guarantees. But a HCP who goes into a situation promising that they will act in their professional capacity if needed, knowing that they won’t actually be able to do so, that just seems wrong. And even worse seems to be forcing the HCP into a situation where they don’t want to be there because they know they can’t act properly in their professional capacity!

Sarah

I’m not familiar with US liability laws so would have to take the word of US posters.

maidmarian555

My problem with being put on a multi-bed post-natal ward was that it meant I couldn’t have my partner stay with me overnight, even though I was in no fit state to take care of my son alone and there was no nursery to send him to. I was told the following day that if I wanted to pay for a room, they had plenty of spares down at their stand alone birth centre and we could have a night there for £50… I know other people who’ve kicked up a fuss and been given single rooms at a charge in the same hospital. Which would indicate they do actually have the rooms, they just aren’t offering them to patients based on need.

Mattie

I agree that it’s awful that partners can’t stay (although partners shouldn’t be staying JUST to help care for the baby, that should be the hospital staff’s job). I’m not sure on the logistics of having women not on postnatal wards though, who cares for them? Would the postnatal ward midwives have to leave to check on women in other parts of the hospital, or would labour midwives have to take on the responsibility?

Sarah

I don’t agree it’s awful, not considering how many women are cared for postnatally on wards. Partners in single rooms are ok.

Mattie

I think it should be up to the women, I don’t view partners as a risk to other women. Many hospitals now are allowing partners to stay, which if the women want that is great, but they shouldn’t be viewed/used as an ‘extra pair of hands’ to provide infant or postnatal care.

Sarah

Well, some of them will be a risk to other women. If you take any group of 0.7 million mostly men per annum, you’re not going to get any who aren’t a risk.

But it’s not just that. It’s the lack of space and facilities if you double the number of people in a ward. They’re already crowded, hot and noisy. Take it from someone who’s actually stayed on one. And it also potentially creates a situation where, in what is already a resource strained environment, the woman with the partner most able to cause a rumpus and advocate loudly gets the best care. Thus fucking over women who don’t have a partner who can come and look after them.

It’s also very naïve to think, in our cost cutting environment currently, that they wouldn’t be turned into a resource to provide postnatal care. Again, throwing women who don’t have anyone to come in with them under the bus.

So no, partners on wards is a bad idea. There is a reason why the NHS is moving away from mixed wards in every other context: it’s to protect the dignity of patients. Private rooms, yes absolutely.

Mattie

Fair enough, I think we’ll have to agree to disagree. Although I do agree that single rooms would be better, I just don’t think the NHS is in a financial position to offer that yet.

Sarah

Agree to disagree about some of the men being a risk to other women, about us as a society trying to abolish mixed wards in every other context, or about them taking up space and resources in already very crowded postnatal wards? That’ll be a no.

If you accept those things are a factor but still think it would be better to allow all women their partners there, ok, but in that case I’d like to hear how you’d plan to manage the consequences of this for women who don’t have a partner there to support and advocate for them.

I agree about both single rooms and the finances though.

Mattie

Agree to disagree on both. I don’t think partners pose a threat to other women, because I don’t think strange men pose a risk to women. I get that they take up space, but not resources…we don’t need to feed them if they are not patients. I don’t think that women who do have partners (this doesn’t need to be romantic partners, just birth supporters) should be punished because some people don’t. Life isn’t always fair and sometimes people will have advantages you do not.

Sarah

Not that I think the violent men point is the most important here, but you don’t think strange men ever pose a threat to women? You must be living on a different planet to the rest of us.

In terms of resources, it’s not just food. Space is a resource, as are toilets and bathrooms. And men do take food on the postnatal wards. It happens. That’s not a matter of opinion. My husband got mine for me on occasion, the servers would have no way of knowing if he were eating it or me.

As for punishment, that appears to suggest you think women who don’t have partners who can stay over should be the ones getting punished instead? Nice.

Bear in mind also that these are likely to be women who are more lacking in resources: if eg you have no family nearby and other children to be cared for while you’re in the postnatal ward, if you have money you can pay someone else to look after them (or indeed stay in the ward with you). If you don’t, your other half will have to stay at home to do childcare while you’re on your own. If you’re an asylum seeker in NASS accommodation, if your partner and the people you know are in insecure zero hour work and can’t turn down a shift or they get no more, if your partner is in prison, if you’ve been moved away from your support network because you needed temporary housing and you were living somewhere expensive before, if you’re insecurely housed yourself… you’re less likely to be able to call on someone to come and stay with you. But eh, let’s punish women who are already disadvantaged. Life’s not fair, after all.

Incidentally, will you be advocating for a return to mixed sex wards in all other areas of hospital medicine, or is it just postpartum women who get this joy?

Dr Kitty

Mattie-
Six or four bed bays are NOT an appropriate place to have male partners stay 24/7.

Women will be in pain, bleeding, in various states of undress, trying to learn to breast feed or express milk, sleep deprived and emotionally fragile.

I wouldn’t want 5 men I don’t know within a 25ft radius, even if it meant I could have 1 I did know there. It would be humiliating, undignified and scary. I don’t mean that I would be at risk of assault- merely that I would not feel safe or comfortable with that many strange men nearby.

Where will the men toilet and bathe, even if they don’t eat?

Curtains will only do so much to protect privacy and dignity and it isn’t acceptable to sacrifice your neighbour’s dignity and privacy so you can have your partner change a few nappies.

I have no objection to partners staying in single ensuite rooms, but absolutely not in shared bays.
Women deserve privacy and dignity.

Sarah

Absofuckinglutely. It’s happening though.

sdsures

So because you have an effective advocate for yourself, you must be made to feel guilty for utilizing it because it “fucks over women who don’t have a partner to come and look after them”??

That’s ridiculous, and it’s yet another way to make women feel guilty for using the advantages (much like formula) they have access to.

Sarah

The guilt is something you have added. Personally, I don’t think we ought to facilitate a situation where this would happen in the first place. I’d like to see us spend more on postnatal care: we could close FMLUs (or at least not build any more of the things) to help fund this. Then we wouldn’t have a situation where women might feel they need someone to help them on the postnatal ward because care is so shit. Where you’re in a position where you need someone to advocate for you to get help.

And some partners are going to be a risk because some people are. You take any group of 700,000 people per annum, and the odds of none of them being a risk to other patients are spectacularly low. I assume you don’t think violent people never have partners who give birth? I can give you a few examples if you do…

I mean, this is not the main reason I’m opposed to partners on postnatal multi bed wards, but it’s entirely unrealistic to pretend a load more non-patients staying over around vulnerable women couldn’t possibly present any risk to any of them.

sdsures

Women are never violent?

Sarah

I expected you’d say that.

It’s a poor argument, though. Because the women who have just given birth are the patients. If they need postnatal treatment, they have to be there, however risky they may or may not be. Women who are too unwell to be discharged from hospital following a birth are rather less likely than the general population to be able to act on any violent inclinations they might have (bear in mind that in the UK, women who have straightforward deliveries are less likely to be in hospital after them, so the postnatal ward will disproportionately contain women who had sections, severe tears etc).

But even if they weren’t, that still wouldn’t be a reason to double the risk of someone sleeping on the ward being a risk to other patients. One doesn’t think oh well, we’ve got to take one risk so let’s take another. In for a penny in for a pound!

AnnaPDE

I’m more wondering how happy most women would be to have the partners of some other women sleeping next to them. Not because they’re scared of them, but for reasons of privacy and because lots of men snore.
Multi-bed wards with lots of babies and strangers are horrible already… adding partners doesn’t really make them that much better.

Sarah

Yep. And place this in the context of the public response to mixed wards when they were more common a couple of decades ago, and the significant efforts made by the NHS to stop adult patients having to be accommodated on mixed wards. Everywhere else, it’s seen as a bad thing.

sdsures

Women never snore? Women are never violent?

KeeperOfTheBooks

Yeah, that privacy factor. I don’t even try to breastfeed anymore, but back when I did, I was extremely uncomfortable doing so in front of anyone except my husband and perhaps one or two very close friends. (I don’t care if anyone else breastfeeds around me or how they do so–I simply don’t like anyone seeing those bits of me except for an awfully short list.) When you’re learning to breastfeed, it’s just about impossible to do and stay even remotely covered up. Being essentially forced to hang my boobs out in front of four or five guys I’ve never met before, plus their wives/girlfriends/SOs? Especially while already feeling vulnerable thanks to the delivery and hormones and whatnot? That sounds horribly traumatizing.

Azuran

Not a risk per se, but I can totally understand a woman feeling intimidated by the presence of other men she does not know. Especially if she has a difficult baby that is crying a lot and her own husband cant be there.
And I’m not saying that men would be mean or anything. But just a sideways look, a whispered comment or sigh could cause massive guilt.

And some people are just dick, but that applied to both men and women.

sdsures

Women never snore? Women are never randomly or purposely violent?

I snore and I’m a woman. My CPAP is helping it calm down.

Azuran

I didn’t say any of those things. I just merely pointed out some things that CAN be intimidating if they are done by men.
Yea sure, women can also be horrible, but I’m pretty sure most women would feel much more comfortable sharing a room with only random other mothers or just random other women then they would with a bunch of random men.

sdsures

Partners are the “extra pair of hands” at home for providing infant care, are they not?

Mattie

Yeh, at home, but not in hospital where it’s the job of the staff on the ward. The partners have often also been awake all night (or longer) with the labouring person. Plus they’re not insured to provide care in the hospital? We need better staffed postnatal wards definitely, so that people who don’t have support can be helped to care for their babies, and so that partners can just be with their families.

maidmarian555

The hospital I was in had small 4-bed wards with single rooms on the same floor for postnatal. It was just that many of the single rooms appeared to be empty. I don’t really see why it would be impossible for them to check you in a different room to other people, they’re supposed to be checking you regularly anyway (there could be a reason but it’s very unclear what that might be or how whatever problem there is can be resolved by you chucking cash at them). Labour and delivery was a totally different floor with different staff (also all single rooms other than the induction suite which could fit about 4/5 women in at a time). They also have an alongside birthing centre, which again was another floor with single rooms full of birthing pools and fairy lights.

The birth centre they offered me a room in is about 30mins down the road and isn’t well used at all. I went home as I didn’t see why I should have to pay for the privilege of having my partner there at night so we were taken care of properly when he could do that at home for free.

AlexisRT

I had my first on the NHS 10 years ago, but I was in a 6 bed bay. No partners on the ward after 9pm.

But you also had to have your baby with you, and they had basically 1 midwife covering the postnatal unit (I think it was 1 midwife + 1 student?) I’d had a Caesarean section, so I had a lot of trouble getting her in and out of the cot without help. It was awful. They wanted to have it all–no professional help, but not let you have someone to help you either.

Sarah

Well, that’s the problem. This push for partners to stay (check out some of the stuff midwife groups have been saying, incidentally) is, if we can be cynical for a moment, cost based. Filling in gaps.

maidmarian555

This seems to be how it is. I don’t necessarily have an issue with partners being sent home but without proper staffing and nurseries too many mothers are being put at risk as a result. I just wish that instead of blaming the mums and making you feel like it’s your fault for not being able to cope (even if you’ve been awake for days, had a difficult birth and/or surgery) that they’d be pushing for better facilities and funding so that everyone can have both the care and the choices they should have. Instead, from what I saw at the hospital I gave birth in, they’re creeping in an insidious 2-tier system where you *can* have somebody overnight with you if you complain and have money. I don’t know if that’s happening in other places but it wouldn’t surprise me at all if it was.

BeatriceC

Unfortunately there’s almost no chance that this decision was primarily for the benefit of pregnant people and newborns. Somebody in NHS saw the numbers and went “oh, shit”. Dead and injured mothers and babies don’t mean anything until it started costing them a whole lot of money. Unfortunately, that’s no different than in the US. We won’t see an end to this madness until the insurance companies start refusing to pay and/or holding hospitals accountable for poor care leading to bad outcomes.

Sheven

Good for the organization for being responsible enough to change, even if that change isn’t perfect.

Martha G

I’ll have some respects for them when they own the decision and at least publicly acknowledge that they were wrong. Until that day, rightly or wrongly, it just appears that the u turn was forced.

sdsures

I hope the change sticks.

mabelcruet

The change was forced on them, primarily through James Titcombe’s relentless campaigning, and despite their endless bullying and intimidation of him. They had no intention of doing this voluntarily or willingly, but the death toll is increasing rapidly and couldn’t be hidden any longer.

Kelly

Good for James Titcombe. She has put him through hell and back. I am so glad that his campaign is finally yielding positive results.

Martha G

This is genuinely great news and must not be allowed to skip quietly under the radar. We owe it to those damaged by this ideology (and I include almost everyone I know who’s had a baby over here, “happy ending” or not) in these category

Anj Fabian

”
I can’t forget the baby George King.

The first child born to his 21 year old mother, he would have been born by cesarean section in the US because he was nearly 15.5 pounds at birth.

Instead he was born vaginally with a horrific shoulder dystocia….

“The six-week-old was born naturally to mother Jade Packer, 21, at Gloucestershire Royal Hospital.

But because his shoulders are so large he got stuck during the delivery and stopped breathing for 20 minutes.

George, who was given a 10 per cent chance of survival, was rushed to
the special baby care unit in St Michael’s Hospital, Bristol.”

An idea of how people change the narrative to fit their own biases…
“His mother bravely pushed him out and despite getting stuck in the birth
canal, he was delivered safely by a staff of almost 20 curious
specialists.”

Curious specialists? Wanna bet that a good deal of them started crapping their pants the moment they realized how big he was? I bet whoever decided that a vaginal route was the best for this child got cussed at least 20 times in these “curious” specialists head. I’m quite sure that a good number of them counted their blessing when they sent him off alive.

I doubt they were curious, as you said. There were 20 specialists because they were pretty sure they’d need 20 fully trained medical personnel to try to save that baby’s life.

Ozlsn

“Curious specialists”?!?!? What in the actual hell?? That is the worst wording for a room full of crash teams that I have ever read. The implication is most definitely that they all just stuck their heads in for a look, when no one has time for that crap – they were there to try and save the baby and quite possibly the mother. Hell I had fewer people for the (planned but technically emergency) delivery of my 1lb baby – and we had a full NICU team ready as well as the normal theatre teams. Sure at least a couple of people were in there as part of their training, but the senior consultants sure as hell weren’t.

And yes, that is not “delivered safely” as I know it, that it “we hit the button and we’re focused on keeping everyone alive”.

“Curious specialists.” FFS.

Anj Fabian

I always have to dredge up the details from various sources. Jade, George’s mum, went well postdates with him.

“Jade, who is 5′ 7″, had no idea that her baby with 6′ 2″ Ryan would be
so large. Ryan added the doctors told the expectant parents that
everything was normal until Jade went into labor, 15 days after she was
due.”

That poor mother too. I can only imagine that her injuries were severe in order to get this kid out. Also, who was in charge of her prenatal care? How do you miss a 15 lb baby or diabetes in this lady?

Martha G

Glad it wasn’t just me that was horrified by the reporting of that near-miss. The complete lack of acknowledgement in the comments section that this was not simply a cute story shows just how brainwashed and deluded many of us have become in the UK as a result of exposure to this ideology.

sdsures

Holy shit.

mabelcruet

You can add Soo Downe to that list of enablers, she is as deeply mired in that philosophy as Warwick and Byrom. She’s the one who insists mothers around the world want physiologically normal births, as opposed to a birth which prioritises maternal and baby well-being, and who is responsible for spreading scare stories about how dangerous sections and epidurals are.

Martha G

It’s this arrogant insistance that it is the women themselves crying out for medieval birth that gets me more then anything. Utterly deluded and out of touch. Women I’ve discussed this with almost exclusively want two things: safety and good pain management. A few who don’t bother to do their research or are susceptible to bullshit do want a natural birth, but few remain convinced once contractions start…

The Bofa on the Sofa

I’ve told this story before: when we went through childbirth classes, I asked the instructor at the end why we didn’t spend more time learning about things like breathing exercises and natural birth pain coping mechanisms? She said, she doesn’t bother because 95% of those who deliver just get an epidural.

I know this is above the national average and all, but it just goes to show, that when push comes to shove (pun intended), labouring moms to a large extent prefer pain relief.

Martha G

I watched a TV show set in a maternity unit once where a midwife had come to have her first baby delivered by her peers. After not very long at all, she realised she couldn’t deal with the pain and needed an epidural. How did she convey this to her colleagues? By tearfully telling them she was a failure. Speaks volumes about what she and others in her position obviously thought of her patients when they requested the same privilege.

The Bofa on the Sofa

Yep, they are the ones who consider it a failure. Meanwhile, an OB considers an epidural to be a perfectly normal approach.

swbarnes2

My childbirth class did do some breathing exercises, and one of the students asked why, and the answer was that it’s for handling contractions before you are admitted.

sdsures

Yeah, no. Whoever thought that breathing is sufficient to manage severe pain is full of crap.

sdsures

I would ask how come people getting their appendixes removed aren’t being coached in breathing exercises and natural pain management coping mechanisms.

CSN0116

The US healthcare system has so many flaws, but fuck me if I want an ounce of the UK’s model brought here as it applies to prenatal care and birth. Their postpartum care sounds horrific as well (multiple people to a room, booted 10 hours later, and BFHI policies on steroids).

I will birth in America allllllll day long, thank you. And fight for all to have access _while maintaining_ our humane (often wonderful, apparently) standards.

Martha G

Don’t blame you. And I probably won’t have children if I stay in the UK (though this is at least encouraging).

Heidi_storage

Agreed. You in the UK do an outstanding job delivering care to many people–especially within budgetary constraints–but having a baby there sounds unpleasant. (Mind you, I have excellent insurance and access to healthcare, so someone who does not may disagree with me.)

Martha G

To stick up for my homeland for a minute it isn’t all terrible, we do get the choice of whichever hospital we want, and those who have a good GP and I fortunately do can just say “which hospitals don’t have a huge natural birth ideology” and they will recommend one to you.

Also our NICE guidelines do now state that a women is entitled to a c section if she wants one, which is progress. But I think too much does depend on blind luck, who you get to see on the day and being educated/privileged enough to know how to “work the system”. And it shouldn’t be like that.

Christina Maxwell

True, as far as it goes. Not much use if you live in an area with only one hospital offering actual OBs.

Mattie

All hospitals have doctors? Even consultant led women will mostly be cared for in labour by midwives, and most midwives are actually good at their jobs. There’s no need for an OB most of the time (as long as your midwives are doing their job properly) and when they are needed then ‘actual OBs’ are called, along with ‘actual paediatricians’.

The good thing about this, is that hopefully midwifery education and training will improve and the NMC guidelines will be upheld, so less midwives will be ‘natural birth junkies’

Christina Maxwell

No, they do not. In my area we have one big hospital with full OB staff, NICU etc. Then we have the smaller hospital 25 miles away with a midwife led unit and no OBs or NICU plus 3 further offsite MLUs with no OBs within 30 or 40 miles. The distance from the far north of the area to the big hospital is 70 miles or so, on some pretty dodgy roads.
Sure there’s no need for an OB most of the time but when there is and you are 40 miles from him or her you are comprehensively stuffed and so is your baby. There have been deaths to prove it, unfortunately.

Mattie

Ok, yeh, that’s shocking! Is it just a birth centre? Do they not even have like 1 obstetrically trained doctor on staff at all? Sorry, I didn’t even realise that was allowed to happen at a hospital. Not having a NICU is one thing (and tbh it happens a lot, because NICUs are small and sometimes they close) but wow that’s horrendous. Have people complained/campaigned?

mabelcruet

Yes, we have a stand alone midwife unit too in my region. It’s about 20 miles to the nearest hospital. It is staffed by midwives with no medical doctors present. Women delivering there are supposed to be low risk, and there is supposed to be a low threshold for moving women to the medical unit if any complications arise in labour (except given the distances involved it’s unlikely an acute emergency could be treated as quickly as it ideally should be). We also have a ‘home from home’ unit, a midwife led unit that is in the same building as the obstetric led unit in the hospital, which sounds safer to me.

Mattie

Yeh, I know that stand-alone birth centres are still a thing, although I hope that they start closing them and staffing hospital units better. I am just shocked that a hospital can offer such poor facilities, because it seems to be ‘false advertising’ 🙁 plus 1 hospital for a huge area is just logistically poorly planned.

Sarah

I do too. It’s inexcusable, when resources are so thinly stretched, so many are underused and virtually every hospital that does births has an in hospital MLU.

Empress of the Iguana People

…god I hope our friend Erin and her 2nd are doing alright.

Box of Salt

Every time the UK situation pops up in any comment thread I wonder how she is doing and hope she and her family are OK.

BeatriceC

I’ve been thinking a lot about her. The longer she goes the more I fear the worst.

Empress of the Iguana People

me too.

Christina Maxwell

It used to be a proper unit with OBs on site, my 2nd daughter was born there in 1987. There were huge protests when they tried to shut it down completely, so the compromise was a MLU. There is no obstetrically trained doctor. Theoretically I suppose a non OB general surgeon could charge down the hill from the main site (which still does other hospital type stuff) but only between the hours of 9-5 Monday to Friday!

Mattie

God! That actually is horrific 🙁 I would imagine the main hospital must be horribly oversubscribed, if it’s the only hospital for what I imagine is quite a large area. I personally don’t think stand-alone MLUs are all that safe, although I do like MLUs within the main site/within walking distance of an OR and emergency care. Midwives are well trained, they can cope alone with a lot of emergencies, but that doesn’t mean they should have to, or that women should have to risk that. If I chose a hospital birth, I would expect the hospital to be a proper hospital…not a stand-alone MLU in a hospital building.

Christina Maxwell

Exactly! I think attached MLUs are a great idea, it just hacks me off a bit that they are so much nicer and more comfortable than the OB units!

Mattie

Definitely!! Some of it is practicality, they need to have more equipment, a bed etc… but a lot of it is funding, it’s a lot easier to get people to donate for a ‘new’ thing, than to redecorate an old thing.

Sue

That compromise has occurred in a few places in Aus where the small local hospital is considered unsafe for general obstetrics, but the local community won’t accept closure of the unit.

The compromise requires very tight risk-outs, with transfer of a lot of women who could possibly deliver locally if the unit were safely staffed.

Sarah

Yeah, FMLUs are a problem. I’m a supporter of hospital based MLUs for those women who want them, and plenty clearly do, but FMLU no.

Maybe it’s just my cultural backgr, but this is exactly the attitude that creeps me out about the UK approach to maternity care. No, a midwife is not enough. Yes, I do want an actual doctor and regular scans – you know, the actual medical monitoring that makes childbirth safer, by the kind of person the midwife refers you to if she happens to realise that there is something dodgy and is not caught up in her normal birth bubble. Let’s just cut out the middle-woman. Just like you go to a trained doctor for all other medical needs, and not a nurse.
I’m lucky enough that in all countries where I’ve lived, standard maternity care was done by doctors, with midwives the add-on for whoever would like them.

Sue

Does the NHS cater to GP-shared care?

Many Australian GPs do antenatal care in partnership with an OB, but only rural ones generally manage the delivery.

Public hospital births are (nurse specialist) MW-based with on-site residents and on-call OBs in consultation.

mabelcruet

Some GPs do offer maternity services in the UK but very few-its something they can choose not to take part in. It’s been changing gradually for many years-in the 60s and 70s there used to be GP maternity units and far more home deliveries (I was delivered at home by our GP, and 18 years later he gave me his anatomy skeleton to take to medical school!). There was a huge shift in GP funding and contracts in 2004/5, and maternity services by GPs were no longer separately funded. That tied in with a big thrust from the midwives RCM about pregnancy not being an illness (their normal birth initiative started in 2005 I think) so the goal of that was to de-medicalise pregnancy and reduce medical involvement.

Technically, women can self-refer directly to midwives without going via the GP. She can still attend the GP with health issues, but the midwife is first port of call for pregnancy related stuff.

Empress of the Iguana People

Awwe. Ew, but awwe.

mabelcruet

He was a very traditional village GP-he was single handed, did 24 hours a day oncall (no one to cover for him), his surgery was in his home and his wife was the receptionist/nurse/gofer. He lived in a very grand Victorian villa, and his office/treatment room was where you’d have a formal dining room. He used to collect teapots-he had hundreds on a high shelf all around his room. It was only looking back that I worked out that was how he decided if you were properly sick as a kid-he used to ask you to find the teapot from China, or the teapot shaped like an elephant. If you were easily distracted and could concentrate to find the teapot, then you weren’t sick!

He was the only GP in the village for many years, and when he died, the local paper was full of stories about him, and virtually everyone mentioned his teapots.

BeatriceC

That sounds like the basic set up in the show “Call the Midwife”, except they were in a particular neighborhood in a city and not a village. But still, on GP, office run by his wife (after he got married again, first wife died), on call 24/7. I’ve definitely been curious how accurate that show is about how medical care worked during that era. It seems pretty reasonable based on my non-expert knowledge.

mabelcruet

That way of working is completely unsustainable now, thankfully, but yes, my impression is that the programme is reasonably accurate.

BeatriceC

Oh, of course it’s unsustainable now, but I still like reading/watching stuff set in era’s gone by, and am always curious how accurate the portrayals are.

Dr Kitty

As a medical student in Dublin about 12 years ago I was attached to an urban GP practice in the greater Dublin area for a week.

Ireland has a rather eccentric mix of private insurance and single-payer, and GPs are self employed with a curious lack of overarching regulation.

The practice I was attached to was a family practice- the son had joined his father’s practice about 5 years before, and the father retired shortly before I arrived.
They were very proud of their new patient record system, which the son had introduced.

You see, the father had a photographic memory, and so he rarely kept paper records, and those he did were cryptic scribbles on the backs of envelopes.

The son had finally introduced a proper paper record system!

This was 2005… long after most people had moved to computers they had just introduced index cards!

I spent another week as student in a husband and wife rural practice. Their patients were mostly elderly farmers and often couldn’t afford the €40 consultation fee and so paid in eggs, garden produce, rabbits, pigeons and salmon (poached). They DID have paper records… mainly because there were only five surnames in the area and so they had multiple patients with the same name and had to keep them straight by assigning them numbers.

NHS GP computer systems and the single payer system aren’t perfect, but they are a damn sight better than calling “Patrick Murphy- number 223” while you scramble for an illegible handwritten index card, and the patient dropping a brace of pheasant on the desk as he leaves!

Dr Kitty

Me! Me!
I do shared care!

No deliveries (amongst other things, the medical indemnity costs would be astronomical), but I do routine antenatal care and postnatal appointments.

I really enjoy it.

As life is not always a bed of roses, I can provide ongoing continuity of care for a pregnancy loss, a traumatic birth, breastfeeding problems, PPD, pelvic organ prolapse, continence issues, psychosexual and relationship problems, contraception, parenting queries- you name it. Your GP is for life, not just for pregnancy!

I also get to write pointed letters to the local heads of midwifery on a semi-regular basis when patients confide particularly egregious episodes of poor care.

Christina Maxwell

Sue, it used to. I had it with my 2nd and again with my 3rd. Back in those days many GPs had extra obstetric training as well, specially in rural areas. It was a better system in my opinion.

Martha G

We do have regular scans. There are problems I agree, but the way it is supposed to work is that you are only allowed in a standalone midwifery unit if considered very low risk. Where the problems start is when the thresholds for what constitutes low risk start to be eroded, and its not hard to see how natural birth ideology could influence that.

Christina Maxwell

Yes, for sure. My daughter was ‘encouraged’ to go to the MLU with GD and rapidly increasing blood pressure. Luckily she refused and had her daughter in the OB unit with an induction at 39 weeks, an epidural (which she hadn’t thought she wanted) and ultimately forceps, very well handled by the OB consultant. Funnily enough the birth followed exactly the same pattern as her own 30 years earlier!

Empress of the Iguana People

That can happen in any system. There’s a hospital 3 blocks from me. They do not have a ped or an ob. Lots of geriatric specialists, though.

BeatriceC

Most of the hospitals around here technically have pediatricians on staff, but they pretty much function only to stabilize the child long enough to arrange for a transfer to the large tertiary children’s hospital.

Sue

The best thing about the NHS is universal access. Choice may be limited, but you don’t see ppl bankrupted by health care costs.

Toni35

Bankruptcy fucks your credit for seven years. You keep your home, your car, and most personal possessions. You can come back from bankruptcy.

If you or your baby dies, that’s forever.

This is why so many Americans are against single payer systems. Many would rather be bankrupt than dead.

Sarah

Although of course, our system stops some people from dying who’d be shit out of luck in the US because of the system there…

I have no doubt the US is better if you’ve got resources. It’s just a bit more difficult when you don’t.

Toni35

How so? Anyone, regardless of insurance status, can go to a hospital (or call 911 and get there via ambulance), and so long as said hospital accepts Medicaid, emtala applies and they will be kept alive. They may face six figure bills afterwards, but they will be alive. It’s not ideal, obviously, but like I said, you can recover from bankruptcy. You can’t recover from death.

Sarah

Just to be clear, are you suggesting nobody in the US has died through lack of access to healthcare?

Cat

My main problems with the system were that:

– Having been assessed as low-risk and suitable for midwife-led care in a twenty-minute appointment by a GP (whom I’d never met before), it was a real battle to get to see anyone but the community midwife for the rest of my pregnancy. The theoretical right to choose a c-section doesn’t mean much if your midwife is fanatically pro-natural birth and bullies and fights you when you try to get access to a second opinion.

– There’s a lot of pressure to labour at home until the absolute last possible moment because hospitals can’t take the numbers. This is dressed up as being in your best interest because being in hospital will supposedly cause your labour to stall. I have a friend who nearly gave birth in a coffee shop at the hospital because she was repeatedly told to go home and wait longer (and she was a second-time mother who could be expected to know what she was talking about when she said how far apart her contractions were).

– Speaking from a sample of four hospitals only, there seems to be a ridiculous amount of promotion of bloody hypnobirthing.

Mattie

You’re not automatically ‘booted’ 10 hours later, and yes most postnatal wards are multiple bed bays…we don’t have the money nor the staff for private rooms for everyone. We do have midwives doing home visits postnatally, which is way better than in the US. Antenatal care is also pretty good. Yes, there are problems, but it’s not that bad.

fiftyfifty1

“Yes, there are problems, but it’s not that bad.”

..unless your baby (or you) dies…

Mattie

Just because there are problems, doesn’t mean everything about the care model is terrible. Women and babies die in the US in hospitals too, and probably a lot of the time for similar reasons. Neither system is perfect, and both systems could stand to try to learn from the other, rather than writing one off as “100% awful”

Christina Maxwell

Nobody said it was 100% awful. It is however fairly dismal a lot of the time. The argument that ‘women and babies die is US hospitals too’ is true but completely irrelevant to this discussion which is not about improving US maternity care.

Mattie

The quote was literally “I wouldn’t want an ounce of the UK’s model brought here” that does suggest that the OP thinks the UK system is 100% awful, if you can’t recognise the positives and negatives then you can’t actually make any sort of plan to improve things.

And actually is IS relevant, because like I said, there are positives and negatives to both systems, and why would we want to limit debates to only improving maternity care in one country? If people in the US and UK worked together, to learn from each system, then perhaps we could improve outcomes for more pregnant people and babies.

I’m not even talking about the national health vs insurance thing, although of course that’s a key difference. But things like testing for GBS in pregnancy, the US manages that very well, but the UK manages out of hospital postnatal care very well. Our antenatal care set-up is pretty good too, although we could do with looking to the US for management of late pregnancy/post-dates.

Christina Maxwell

I am glad that you live in an area of the country where things are better. Hopefully areas like mine, and my daughter’s, and those of a lot of my friends (all different, England, Scotland and Wales) can learn from them.

Mattie

Yes, it does seem (like many aspects of the NHS) to be an unfortunate postcode lottery, once again it is up to individual Trusts and even individual hospitals and staff members to apply and enforce the general policies. The policies might be great, but if they’re not being stuck to then they may as well not exist.

Sarah

Yes, the not an ounce part was a bit much. There are some things in the UK that are indisputably superior to the US. Universal access, for one. That is just plain better. I think the US could also benefit from providing more in hospital MLUs, for those women more inclined towards unmedicated midwife led delivery but wanting to be down the corridor from theatre if necessary.

There are also a great many other things we could learn from the US on. In hospital postnatal care, for a start. And MRCS availability.

sdsures

We also have health visitors who come regularly to visit after the birth, to make sure the baby and new parents are settling in well. They are distinct from midwives.

Alas, it used to be a lot better. I know: I studied midwifery in Cambridge in the mid 70s and it was excellent. At the time, the quality of UK midwives (all registered nurses, btw) was regarded as the best in the world, and the care, both in hospital and on the district, was superb.

Sarah

You can choose to stay on postnatal if you want to. You just generally wouldn’t!

Daleth

Wow! I so glad they’re finally changing! It’s just tragic that so many babies were killed or injured before they figured this out.

Sarah

Does anyone here have any contacts with Maternity Outcomes Matter? I have tried to contact Maureen Treadwell through the BTA page, but doesn’t seem to be working:

Amy Tuteur, MD

Dr. Amy Tuteur is an obstetrician gynecologist. She received her undergraduate degree from Harvard College in 1979 and her medical degree from Boston University School of Medicine in 1984. Dr. Tuteur is a former clinical instructor at Harvard Medical School. She left the practice of medicine to raise her four children. Her book, Push Back: Guilt in the Age of Natural Parenting (HarperCollins) was published in 2016. She can be reached at DrAmy5 at aol dot com...
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